Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TE1000421 | PA |
NPI | 1013101518 |
---|---|
Provider Name | Nicole Heidelbach |
First Address | Monongahela, PA 15063 |
Second Address | Bethel Park, PA 15102-3106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2007 |
Last Update Date | 06/12/2013 |